Learning Objectives Students will be able to: 1. Understand health care issues and the challenges of an aging society. 2. Describe key enacted and proposed legislation affecting healthcare services for older adults 3. Identify various methods for structuring and paying for healthcare services for older adults. 4. Examine the social, political and provider response to the corporatization of healthcare. 5. Analyze provider incentives and utilization review approaches used to contain costs. 6. Analyze the relationship between payment structure and cost to consumers, providers and third party payers, including the government. 7. Assess what is known about the relationship between healthcare delivery models and health-related outcomes. 8. Describe how managed care delivery models affect the financing and delivery of long term care. 9. Describe how long term care insurance impacts the delivery of healthcare for older adults. 10. Describe innovative demonstration projects and state models of managing chronic care. Final Paper This requires writing an in-depth analysis/state of the art paper of an innovative health care delivery model or system. Some examples may include: TEFRA, Medicare Advantage, IPAs, PACE, Long Term Care Waiver Programs or other innovations that affect the healthcare delivery for older adults. Or, students may select a current issue related to healthcare reform, managed care, quality of care, outcomes research, care coordination, disease management and examine how this area affects the healthcare delivery for older adults.((( I choose Medicare Advantage and I attached the Executive Summary here))) The paper should be no more than 22 pages, typed, double-spaced in 12-pitch Times Roman font. Leave one inch margins on each side for my comments. You should address the following in both your midterm and final papers: 1. What is the program or topic that you have selected and why is it important to older adults? 2. What is the legislative history of the program or topic? When did it originate and how has it changed over time? 3. What are the major features/tenets/guiding principles/components of the program or topic? 4. How does the program impact the elderly? Who does it benefit and how? What are the major issues in terms of the concepts discussed in class? 5. What do you see as the future issues that confront this particular area? 6. What changes or modifications would you make to impact the program or topic in a more positive way and why? Grading Criteria for the final paper: Comprehensiveness: Is your analysis comprehensive? Have you briefly delineated the key issues and historical stages? (50%) Execution: Is your paper well written, presentable, and well organized? Is it grammatically correct? (15%) Documentation: Have you included references to the literature (especially class readings and a bibliography)? Use parenthetical references, e.g. (Torres-Gil, 1992). Do you handle the concepts well and use the readings appropriately? (25%) Creativity and Original Thought: Do you bring anything new or original to your discussion? Do you look at issues in a new light or suggest new ideas in your paper? (10%) Executive Summary: “Medicare Advantage” Medicare Advantage is an addition to the current Medicare package that addresses many of the discrepancies or disadvantages of the more common Medicare program. Most especially, it is offered by private insurance companies, rather than just through the federal government and offers more comprehensive care than the federal government can (although changes have been made due to the Affordable Care Act that will be addressed in the Final Paper). Signed into law by the Balanced Budget Act of 1997, Medical Advantage provided an alternative to the standard Medicare package by “expand[ing] the role of private health plans, such as HMOs, PPOs, provider-sponsored organizations (PSOs) and private fee-for-service (PFFS) plans to serve Medicare beneficiaries, who could either choose to enroll in Medicare+Choice or remain in the original Medicare fee-for-service program” (Shi and Signh 213-214). So the shift that took place, especially considering that it was part of a Balanced Budget Act, was to lower the burden on the federal government, and instead place it on employers and private beneficiaries. However, the Medicare Advantage would also pay for other programs, such as the Medicare Advantage Prescription Drugs Plans (for which most beneficiaries were already paying exorbitant amounts) and the Medicare Advantage Special Needs Plans, which would greatly reduce the amount being paid for long-term care for patients with Alzheimer’s, Parkinson’s, or in need of institutionalized care. By paying into Medicare Advantage from an early enough age (to whom it was largely marketed), patients in later years of their lives would better covered than just your standard Medicare, while reducing the federal budget. But it also disadvantages those already too old to truly benefit from it. The original Medicare program was established in 1966 during the Johnson administration. These kinds of programs, especially in light of Lyndon Johnson’s “The Great Society” program, was heinous federal over-reaching to most Republics, who attempted to overturn or defund this program at every step of the way. But the program proved to be immeasurably helpful (if more than a bit complicated to its bureaucracy and practitioners. Like Roosevelt before him, Johnson was attempting to lead to country to “Freedom from Want,” and Medicare would allow the elderly to not worry about strenuous and sometime cruel medical costs. The addition of the Medicare Advantage provision may or may not have damaged the original system in place. It is my intention to analyze the advantages and disadvantages of Medicare Advantage; find who the true beneficiaries are: the federal government or patients, with or without money; and track the changes that may have taken place in light of the Affordable Care Act. Is such a law on the books redundant now or is even more necessary due to the protections and help it provides? When so many American citizens are struggling with rent, with groceries, with car payments, with gas and insurance, perhaps their health need not be the silver bullet that not only puts them under the poverty line, but out on the streets, especially while in the throes of a debilitating that devours them. Is Medicare Advantage a system that works, or just another bureaucratic complication? This is what I wish to explore and decide for myself.
